单纯前路手术治疗下颈椎脱位伴脊髓损伤

Anterior approach surgery for lower cervical spine dislocation combined with spinal cord injury

目的探讨颈椎前路手术治疗下颈椎脱位伴脊髓损伤的疗效。方法采用回顾性病例系列研究分析2011年1月—2018年8月中国康复研究中心北京博爱医院收治的72例下颈椎脱位伴脊髓损伤患者临床资料,其中男55例,女17例;年龄18~63岁,平均35.8岁。脊髓损伤节段:C32例,C416例,C624例,C730例。美国脊髓损伤协会(ASIA)分级:A级43例,B级22例,C级6例,D级1例。患者均行单纯前路减压复位融合钉板固定术。记录手术时间、术中出血量、减压复位、融合情况、并发症及ASIA分级。结果患者均获随访3~72个月,平均24.2个月。手术时间为90~180 min[(118±58)min];术中出血量为50~180 ml[(104±30)ml]。患者脊髓均得到减压。复位情况:优58例(81%),可14例(19%)。48例(67%)确认融合成功。并发症包括颈前、血肿和喉头水肿各1例,脑脊液漏4例,轴性疼痛2例,均在及时处理后好转。术前ASIA分级A级患者中2例恢复至B级,1例恢复至C级;术前B级患者中1例恢复至C级;术前C级患者中2例恢复至D级(P>0.05)。结论对于下颈椎脱位伴脊髓损伤患者,单纯前路手术可以获得良好的减压、复位和融合效果,但对神经功能改善帮助有限。

Objective To explore the curative effect of anterior cervical surgery for lower cervical dislocation combined with spinal cord injury.Methods A retrospective case series study was carried out to analyze the clinical data of 72 patients with lower cervical dislocation and spinal cord injury admitted in Beijing Boai Hospital,China Rehabilitation Research Center from January 2011 to August 2018,including 55 males and 17 females,with an average age of 35.8 years(range,18-63 years).The segments of injury were at C3 in 2 patients,at C4 in 16,at C6 in 24 and at C7 in 30.Bases on American Spinal Injury Association(ASIA)grade,there included grade A in 43 patients,grade B in 22,grade C in 6 and grade D in 1.All patients were treated with anterior decompression and fusion.Operation time,intraoperative hemorrhage,decompression and fusion,complications and ASIA grade were observed.Results All patients were followed up for 3-72 months(average 24.2 months).Operation time was 90-180 months[(118±58)minutes]and intraoperative bleeding volume was 50-180 ml[(104±30)ml].Spinal cord was decompressed in all patients.The reduction was excellent in 58 patients(81%)and fair in 14 patients(19%).Fusion was confirmed in 48 patients(67%).The complications were improved after timely treatment,including cervical edema in 1 patient,laryngeal edema in 1,cerebrospinal fluid leakage in 4 and axial pain in 2.ASIA grade change of spinal cord injury:grade A were recovered to grade B in 2 patients,grade A to grade C in 1,grade B to grade C in 1,grade C to grade D in 2(P>0.05).Conclusion For dislocation of lower cervical spine combined with spinal cord injury,anterior surgery can obtain good decompression,reduction and fusion effect,but it has limited help for improvement of neurological function.